Obamacare Makes Men Pay for Maternity Care. Good!

November 5, 2013

Stories of real-life Obamacare “rate shock” have revived an old debate. Previously, health insurers could charge women higher premiums than they charged men. Insurers could also exclude maternity benefits. Obamacare prohibits those practices and conservatives are angry. Why should men have to pay higher insurance prices for services they will never use directly?

The issue came up last week, when Health and Human Services Secretary Kathleen Sebelius testified before a House Committee. "To the best of your knowledge has a man ever delivered a baby?" Representative Renee Elmers of North Carolina asked sarcastically. It's sure to come up again, so here, for the men unhappy about this change, are four reasons all policies should cover maternity care and other women's health services—even if it makes those policies more expensive.

1. Healthy mothers and babies are good for you. Society has a legitimate, and very clear, financial stake in the health of pregnant women and young children. As Eduardo Porter noted recently in the New York Times, the U.S. has fallen behind peer countries when it comes to prenatal health. That has long-term consequences for prosperity and inequality, primarily because of the long-lasting effects it has on chlidren as they develop. Obamacare's requirement of maternity benefits won't fix that problem, Porter notes, but it offers a chance to make the problem less severe.

You can think of it as a public investment, just like roads, schools, and power lines—goods for which we all help pay, regardless of actual use. Tom Harkin, chairman of the Senate Health, Education, Labor and Pensions Committe made that point on Tuesday, while Marilynn Tavenner, the director of the Center for Medicare and Medicaid Services, was testifying.

Now, I must say there was a story the other day in the paper about somebody who said, “Now I got — I have to take this policy that covers maternity care. My wife and I are not having more children. Why should I have to have a policy that covers maternity care?” I got to thinking about that. I thought, you know what? Maybe because my wife and I do not have any more children and they are grown up, maybe I should not have to pay property taxes to pay for my local schools. Huh? Why should I worry about it? Maybe only people who have kids going to the public school should pay for it. We are better than that in this country. We are talking about being part of our society. It is to our benefit, my wife and I, to support our local schools because that is our next generation, we want them well taught. Same with health care. It is a values system.

2. You may never bear children. But your mother did. This was a point that Senator Debbie Stabenow famously made several years ago, in response to Senator Jon Kyl, who had raised this same objection. We don’t think of health insurance as an intergenerational transfer, but in some respects it is. In this case, men who help pay for pre-natal and maternity costs are helping to shoulder the burden for costs that their parents bore, many years before.

3. She supplies the womb, but you supply the sperm. This point isn’t as obvious as it may seem. Last week’s controversial Circuit Court decision on contraception deplored the “compelled subsidization of a woman’s procreative practices,” as if humans could reproduce asexually. Of course, procreation—and maintenance of equipment necessary for it—is much easier for men than women. As Stephen Colbert noted (see video below) “we still don’t get to pass a cantaloupe with toenails through our genitals!” But is that a reason men should get to pay less? I know a few women who might argue the opposite.

4. So you ended up XY instead of XX. Get over yourself. Even conservatives generally stipulate that insurance should protect people from the financial consequences of random events. But they seem not to recognize that being born a woman is a random event. Sorry, dudes, you had no control over that. Allowing insurers to discriminate based on gender means penalizing half the population, just because those folks ended up with one type of chromosome instead of another.

Of course, if you acknowledge point number 4, it has some implications for the rest of the health care debate. If we’re not going to make people pay higher premiums because of genes that determined their gender, then what about people born with genetic abnormalities? Or predisposition to diabetes, heart attack, or cancer? Pretty soon you end up arguing that it’s wrong to charge higher premiums to people who, through no fault of their own, happen to need more medical care—thereby conceding one of Obamacare’s core principles.